Suture-implant construct and method of deploying the same

ABSTRACT

This disclosure relates to suture-implant constructs, surgical devices configured to deliver suture-implant constructs, and methods of repairing damaged tissue.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a divisional of U.S. patent application Ser. No. 15/864,948,filed Jan. 8, 2018, the disclosure of which is incorporated by referencein its entirety herein.

BACKGROUND

This disclosure relates to a suture-implant construct, a surgical deviceconfigured to deliver the suture-implant construct, and a method forrepairing damaged tissue. Orthopedic procedures are often performed torepair musculoskeletal injuries, such as those sustained during sportingactivities. Tears in the meniscus are known to be repaired by deployingimplants on either side of the tear, tensioning suture between theimplants to close the tear, and allowing it to heal.

SUMMARY

This disclosure relates to suture-implant constructs including one ormore sheaths and a flexible strand, such as a strand of suture, suturetape, and the like. The disclosure also relates to surgical devicesconfigured to deliver the suture-implant constructs and methods ofrepairing damaged tissue. An exemplary suture-implant construct includesa strand of suture and one or more sheaths arranged to provide aplurality of spaced-apart anchor portions. When used to repair a tear ina meniscus, for example, the disclosed arrangement resists“tear-through”.

A suture-implant construct includes, inter alia, a strand of suture andone or more sheaths and each sheath comprising a plurality ofspaced-apart anchor portions.

A surgical device includes, inter alia, a cannula, and a suture-implantconstruct comprising a strand of suture and one or more sheaths, andeach sheath comprising a plurality of anchor portions. A first anchorportion can be in a deploy position with respect to the cannula and asecond anchor portion can be in a standby position proximal to the firstanchor portion. A surgical device can further include a pusher moveablewithin the cannula to deploy the first anchor portion and to move thesecond anchor from the standby position to a deploy position.

A method includes, inter alia, moving a pusher of a surgical device in adistal direction to deploy a first anchor portion of a suture-implantconstruct out of a cannula and to move a second anchor portion of thesuture-implant construct distally within the cannula. The suture-implantconstruct has a strand of suture and one or more sheaths, and eachsheath comprising a plurality of anchor portions. A method can furtherinclude moving the pusher in a proximal direction and subsequentlymoving the pusher in the distal direction again to deploy the secondanchor portion out of the cannula.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates an example surgical device held by a user, such as asurgeon.

FIG. 2 is a perspective view of the surgical device of FIG. 1 with asuture-implant construct and a pusher partially removed from thesurgical device for purposes of illustration.

FIG. 3 is a top view of a distal end of the surgical device, andillustrates the arrangement between a cannula and the pusher.

FIG. 4 is a side view illustrating a shuttling rack.

FIG. 5 is a side view illustrating the distal end of the pusher.

FIG. 6 is a cross-sectional view illustrating the surgical device withthe entire suture-implant construct loaded into the cannula.

FIG. 7 is a view of the surgical device penetrating a meniscus in afirst location adjacent a meniscus tear.

FIG. 8 is a cross-sectional view illustrating the surgical device with afirst anchor portion deployed.

FIG. 9 is a view of the surgical device as the first anchor portion isdeployed in the first location adjacent the meniscus tear.

FIG. 10 is a cross-sectional view illustrating the surgical device witha second anchor portion moved to a deploy position.

FIG. 11 is a view of the surgical device penetrating a meniscus in asecond location adjacent the meniscus tear.

FIG. 12 is a cross-sectional view illustrating the surgical device withthe second anchor portion deployed.

FIG. 13 is a view of the surgical device as the second anchor portion isdeployed in the second location adjacent the meniscus tear.

FIG. 14 is a top view of the suture-implant construct with the secondanchor portion deployed in the second location.

FIG. 15 is a view of a closed meniscus tear.

FIG. 16 is a top view of another suture-implant construct with thesecond anchor portion deployed in the second location.

FIG. 17 is a perspective view of another surgical device loaded with asuture-implant construct that has more than one sheath.

DETAILED DESCRIPTION

This disclosure generally relates to surgical devices and methods forusing the same, such as is disclosed in commonly assigned U.S. patentapplication Ser. No. 15/643,520, entitled Surgical Device and Methods ofDelivering Implants, filed on Jul. 7, 2017, the subject matter of whichis herein incorporated by reference. This disclosure relates tosuture-implant constructs including one or more sheaths and a flexiblestrand, such as a strand of suture, suture tape, or the like. Thedisclosure also relates to surgical devices configured to deliver thesuture-implant constructs as disclosed herein and methods of repairingdamaged tissue. An exemplary suture-implant construct includes a strandof suture and one or more sheaths, and each sheath comprises at least afirst anchor portion and a second anchor portion spaced-apart from thefirst anchor portion. When used to repair a tear in a meniscus, forexample, the disclosed arrangement resists “tear-through”.

A suture-implant construct includes, inter alia, a strand of suture andone or more sheaths each arranged to provide a plurality of spaced-apartanchor portions.

In a further embodiment, each sheath has a first end and a second end,the first anchor portion is adjacent the first end of the sheath, andthe second anchor portion is adjacent the second end of the sheath.

In a further embodiment, the strand of suture passes through a bore ofthe sheath between the first and second ends thereof.

In a further embodiment, each sheath has an increased width dimensionbetween the first and second anchor portions.

In a further embodiment, the first anchor portion includes at least onesplice point in which the strand of suture exits and re-enters the bore,and the second anchor portion includes at least one splice point inwhich the strand of suture exits and re-enters the bore.

In a further embodiment, the first anchor portion includes two splicepoints spaced-apart from one another, and the second anchor portionincludes two splice points spaced-apart from one another.

In a further embodiment, an end of the strand of suture is looped-overand affixed to the strand of suture adjacent one of the two splicepoints of the first anchor portion.

In a further embodiment, the strand of suture includes a bulb adjacentthe first end of the sheath.

In a further embodiment, the strand of suture is a monofilament sutureincluding barbs.

In a further embodiment, the sheath is a tubular sleeve made of aflexible material, such as polyester suture material or the like.

A surgical device includes, inter alia, a cannula, and a suture-implantconstruct comprising a strand of suture and at least one sheathcomprising at least a first anchor portion and a second anchor portion.The first anchor portion can be in a deploy position with respect to thecannula and the second anchor portion can be in a standby positionproximal to the first anchor portion. In an embodiment, third, fourth,fifth, etc. anchor portions of the sheath can be in a standby position.A surgical device can further include a pusher moveable within thecannula to deploy the first anchor portion and to move any subsequentanchor portions from the standby position to the deploy position.

In a further embodiment, the pusher includes a shuttling rack in contactwith the second anchor portion of the sheath when the second anchorportion is in the standby position. Where the shuttling rack can betubular or rectangular. In one embodiment, the shuttling rack includes aplurality of barbs.

In a further embodiment, the pusher is a holder tube that extendsthrough and moves freely with respect to the sheath.

In a further embodiment, the sheath has a first end and a second end,the first anchor portion is adjacent the first end of the sheath, thesecond or subsequent anchor portion is adjacent to the second end of thesheath, the strand of suture passes through a bore of the sheath betweenthe first and second ends, and the sheath has an increased widthdimension between the plurality of anchor portions.

A method according to an exemplary aspect of the present disclosureincludes, inter alia, moving a pusher of a surgical device in a distaldirection to deploy a first anchor portion of a suture-implant constructout of a cannula and to move at least a second anchor portion of thesuture-implant construct distally within the cannula. The suture-implantconstruct can have a strand of suture and one or more sheaths arrangedto provide a plurality of anchor portions. A method can further includemoving a pusher in a proximal direction and subsequently moving thepusher in the distal direction again to deploy the second anchor portionout of the cannula.

In a further embodiment, the anchor portions are implanted into ameniscus to repair a tear in the meniscus.

In a further embodiment, a method includes tensioning the strand ofsuture to close the tissue repair, such as a meniscal tear.

In a further embodiment, the anchor portions are implanted through asurface of the torn meniscus to outside the knee capsule. The sheath canalso cover the strand of suture between the anchor portions and extendalong the surface of the meniscus. In a further embodiment, the sheathhas an increased width dimension on the surface of the meniscus.

FIG. 1 illustrates an example surgical device 10. The surgical device 10includes a handle 12 and a cannula 14 projecting distally (the “distal”direction is labeled in various figures for reference) from the handle12 along a longitudinal axis A. The handle 12 includes a trigger 16,which in this example is a thumb trigger. The trigger 16 is moveable inthe distal and proximal directions (the “proximal” direction is labeledin various figures reference) to move a pusher 18 (FIG. 2), which itselfis moveable within the cannula 14 in the distal and proximal directions.

In one example, the handle 12 may include a spring or other biasingelement configured to bias the trigger 16 in the proximal direction. Inorder to move the trigger 16 in the distal direction, a user U (i.e., asurgeon) uses their thumb, for example, to apply a force to the trigger16 sufficient to overcome the bias of the spring such that the trigger16 slides distally. When the user U releases their thumb, the trigger 16moves proximally back to a resting position under the bias of the springor other biasing element.

The handle 12 may optionally incorporate a brake. In this example, thebrake is selectively activated by depressing a button 20 disposed on anexterior surface of the handle 12. When the button 20 is depressed, thebrake engages the trigger 16, or a structure associated with the trigger16, to hold the trigger 16 in place and overcome the proximal bias ofthe trigger 16. This braking function is useful in some circumstances,such as when penetrating a meniscus with the cannula 14, for example.

The cannula 14 is configured to penetrate soft tissue within the body.To this end, a distal-most tip of the cannula 14 is relatively sharp andmay be tapered or pointed in some examples. Further, the cannula 14 isloaded with a suture-implant construct 22 (sometimes referred to as a“suture construct”), which includes a strand of suture 24 and at leastone sheath 26. A user can position the cannula 14 adjacent a meniscustear, for example, and use the trigger 16 to selectively deploy thesuture-implant construct 22.

FIG. 2 illustrates a distal end of the surgical device 10 with thepusher 18 and suture-implant construct 22 partially removed from thecannula 14 for ease of reference. In this example, the strand of suture24 and the sheath 26 are arranged to provide the suture-implantconstruct 22 with a first anchor portion 26A and a second anchor portion26B. As shown, the sheath 26 includes a distal end 30 and a proximal end32. The first anchor portion 26A is adjacent the distal end and isdistal of the second anchor portion 26B. The second anchor portion 26Bis adjacent the proximal end 32 and is proximal of the first anchorportion 26A. In an embodiment, the sheath 26 and its anchor portions 26Aand 26B are one-piece.

It should be understood that while two anchor portions 26A, 26B areillustrated, the sheath may include additional anchor portions. In oneparticular example, the strand of suture 24 and the sheath 26 arearranged to provide the suture-implant construct with four anchorportions arranged sequentially along the strand of suture 24. In anembodiment, the four anchor portions are space-apart from one another.

The sheath 26 has a substantially tubular body that extends between thedistal and proximal ends 30, 32. In this example, the sheath 26 isprovided by a single, integrated body. The sheath 26 further includes abore 34 (illustrated in phantom) communicating with the distal andproximal ends 30, 32 for accommodating the strand of suture 24. Thestrand of suture 24 is flexible and is passed through the bore 34. Inthe illustrated examples, the strand of suture 24 is encased by thesheath 26 throughout substantially the entire length of the sheath 26,with the exception of a plurality of splice points.

Each of the first and second anchor portions 26A, 26B includes at leastone splice point, in which the strand of suture 24 exits and re-entersthe bore 34. In this example, the first anchor portion 26A includes twosplice points 36A, 36B, and the second anchor portion 26B includes twosplice points 38A, 38B. The strand of suture 24 exits and re-enters thebore 34 through each of the splice points 36A, 36B, 38A, 38B. Thedistal-most and proximal-most splice points 36A, 38B are spaced inwardof respective ends 30, 32 of the sheath 26. When the first and secondanchor portions 26A, 26B are deployed adjacent soft tissue, tension isapplied to the strand of suture 24, which cinches the first and secondanchor portions 26A, 26B, anchoring them in place.

In the illustrated embodiment, the sheath 26 includes a central portion27, which spans the entirety of the distance between the first andsecond anchor portions 26A, 26B. The sheath 26 covers the strand ofsuture 24 throughout the central portion 27. That is, there are nosplice points between the first and second anchor portions 26A, 26B. Aswill be appreciated from the below discussion, the central portion 27 ofthe sheath 26 may be positioned on a surface of torn tissue, such as onthe medial or inside surface of a meniscus. Therefore, this centralportion 27 of the sheath 26 may be positioned adjacent the condyles ofthe knee, for example. In this way, the sheath 26 serves to protect thecondyles of the knee from abrasion that may be caused by the strand ofsuture 24, which may include barbs.

Further, the sheath 26 also serves to prevent “tear through,” which iswhen an implant tears through soft tissue. In the illustratedembodiment, the central portion 27 of the sheath 26 includes anincreased width dimension W₁ relative to the remainder of the sheath 26,such as at locations adjacent the first or second anchor portions 26A,26B, which have a relatively reduced width dimension W₂. In anembodiment, the sheath 26 is substantially circular in cross-sectionadjacent the first and second anchor portions 26A, 26B and is relativelyflat or ovular in cross-section adjacent the central portion 27. Theincreased width dimension W₁ disperses the force applied by the strandof suture 24 over a relatively large surface area of soft tissue, whichreduces the risk of “tear through.”

The strand of suture 24 may be a monofilament suture. In order to keepthe strand of suture 24 attached to the sheath 26, in one embodiment anend 40 of the strand of suture 24 is looped over and affixed to thestrand of suture 24 adjacent one of the two splice points 36A, 36B ofthe first anchor portion 26A. In this example, the end 40 is passedthrough the first anchor portion 26A, and is bent back in the proximaldirection and affixed to the strand of suture 24 at a location adjacentthe splice point 36B. The end 40 may be affixed back to the strand ofsuture 24 by a knot or using some other fixation technique. The resultis a loop 42 enclosing a portion of the first anchor portion 26A. Theloop 42 retains the sheath 26 relative to the stand of suture 24 andensures that the sheath 26 does not slide distally off the strand ofsuture 24.

The suture-implant construct 22 may be referred to as a “soft” constructbecause it is formed of soft materials such as yarns, fibers, filaments,strings, fibrils, strands, sutures, etc., or any combination of suchmaterials. The soft materials may be synthetic or natural materials, orcombinations of synthetic and natural materials, and may bebiodegradable or non-biodegradable within the scope of this disclosure.In an embodiment, the suture-implant construct 22 is made exclusively ofsoft, suture-based materials. The soft materials confer the ability tobe inserted into or through tissue (e.g., bone, ligament, tendon,cartilage, etc.) and then bunch together, collapse, expand, and/orchange shape to fixate the suture-implant construct 22 relative to thetissue.

In an embodiment, the strand of suture 24 is provided by one of thefollowing example types of suture: FiberWire®, TigerWire®, orFiberChain® suture, which are each available from Arthrex, Inc. Itshould be understood, however, that any type of suture may be used,including cored or coreless sutures. In another embodiment, the strandof suture 24 is flat suture, such as FiberTape® or SutureTape® suture,which is also available from Arthrex, Inc. The strand of suture 24 mayalso be a monofilament suture having barbs, as mentioned above. Further,the strand of suture 24 could include any soft, flexible strand ofmaterial, and is not limited to suture.

In an embodiment, the sheath 26 is a tubular sleeve made of a flexiblematerial, such as a braided, woven, or knitted structure made of yarns,fibers, filaments, sutures, or other similar materials, or combinationsof these materials. In another embodiment, the sheath 26 is constructedof polyester suture material. Other flexible materials may also besuitable for constructing the sheath 26.

FIG. 3 illustrates the arrangement between the cannula 14 and the pusher18 from a top view (i.e., a superior view). As noted above, the cannula14 is configured to penetrate soft tissue. To this end, the cannula 14is tapered to a sharp, pointed distal end 44 in this example. Thecannula 14 further includes a tubular bore 46, which receives thesuture-implant construct 22 and the pusher 18. In this example, thecannula 14 further includes a slot 48 in a superior surface thereof. Theslot 48 extends parallel to the longitudinal axis A of the cannula 14.The slot 48 includes opposing side walls 50, 52 which serve to guidemovement of the pusher 18 in a direction parallel to the longitudinalaxis A. The slot 48 may extend along a portion of the length of thecannula 14 or alternatively may extend along the entire length of thecannula 14.

The pusher 18 is configured to deploy a distal-most anchor portion ofthe suture-implant construct 22 and is also configured to move anyadditional anchor portions distally within the cannula. Specifically, inthe example of the first and second anchor portions 26A, 26B, distalmovement of the pusher 18 is configured to deploy the first anchorportion 26A and to move the second anchor portion 26B distally withinthe cannula 14 to a deploy position. A second distal movement of thepusher 18 will then deploy the second anchor portion 26B.

In one example, the pusher 18 includes a rod or shaft mechanicallycoupled to the trigger 16. The pusher 18 is configured to move in thedistal and proximal directions in response to corresponding movement ofthe trigger 16. The pusher 18 further includes a blunt distal end 54configured to push an implant in the distal direction. The distal end 54in this example is a substantially planar surface arranged normal to thelongitudinal axis A. The distal end 54 could be inclined at an acuteangle relative to the longitudinal axis A. The pusher 18 furtherincludes a relatively smooth superior surface 56, and relatively smoothside surfaces 58, 60 configured to slide relative to the respective sidewalls 50, 52 of the slot 48. The inferior surface 62 of the pusher 18includes a shuttling rack 64 in this example, which is configured tointeract with implants to move them distally within the cannula 14.

FIG. 4 illustrates the shuttling rack 64 in greater detail. In thisexample, the shuttling rack 64 is integrated into the pusher 18, meaningthe shuttling rack 64 and pusher 18 are a single, integrated structure.The shuttling rack 64 includes a plurality of barbs 66 projecting fromthe inferior surface 62 of the pusher 18. The barbs 66 each include adistal face 68 and a proximal face 70. The distal and proximal faces 68,70 meet at an apex 72, which provides a relatively sharp point and isconfigured to engage an anchor portion. In this example, the distalfaces 68 are substantially normal to the distal direction and thelongitudinal axis A, and the proximal faces 70 are inclined toward theproximal direction such that they project from the apex 72 at an acuteangle 74 relative to the distal faces 68.

The shuttling rack 64 is configured to move anchor portions distallywhen the pusher 18 moves distally, and is also configured to not moveanchor portions proximally as the pusher 18 moves proximally. Thus,during a sequence where the user U moves the trigger 16 in the distaldirection and the trigger 16 moves back proximally under the bias of thespring, for example, the anchor portions within the cannula will onlymove in the distal direction.

In this example, the pusher 18 does not include barbs 66 along theentirety of its length. Rather, as shown in FIG. 5, there is a sectionof the pusher 18 adjacent the distal end 54 where the inferior surface62 is smooth. The inferior surface 62 may be smooth along a lengthcorresponding to the length of the first and second anchor portions 26A,26B. Alternatively, the inferior surface 62 may have barbs 66 along itsentire length.

In an alternative embodiment, the pusher 18′ of the surgical device maybe a holder tube 90 which extends through the bore 34 of one or more ofthe sheaths 26 via the splice points of each sheath 26, as best seen inFIG. 17. The sheaths 26 may be spaced apart from one another on theholder tube 90. The holder tube 90 and the sheaths 26 may reside in acannula. The holder tube 90 is free to move back and forth relative tothe sheaths 26. The sheaths 26 may be seated inside the cannula suchthat once the holder tube 90 moves behind the sheaths, the holder tube90 will push the sheaths from behind. In this embodiment, the strand 24may be extended or threaded through the holder tube 90 such that eachsheath 26 may slide onto the strand 24 when the holder tube 90 is behindthe sheaths, thereby deploying the first anchor portion 26A and anysubsequent anchor portions of each sheath 26. The end 40 of the strand24 may be affixed to the holder tube 90 in any known manner, such as aloop, a knot, or other fixation technique.

A method of using the surgical device 10 will now be described withreference to FIGS. 6-16. FIG. 6 is a cross-sectional view of thesurgical device 10 and illustrates the surgical device 10 with thesuture-implant construct 22 loaded into the cannula 14. In particular,the entire sheath 26, including each of the first and second anchorportions 26A, 26B, is positioned within the cannula 14. The distal end54 of the pusher 18 is proximal to the first anchor portion 26A, and theshuttling rack 64 is contact with the second anchor portion 26B.

For purposes of this disclosure, the distal-most anchor portion withinthe cannula 14 is in a “deploy position” in which the implant is readyto be deployed by the pusher 18, and any remaining anchor portions arein a “standby position.” The anchor portion in the standby position isessentially waiting to be moved to the deploy position and ultimatelydeployed by the pusher 18. In FIG. 6, the first anchor portion 26A is inthe deploy position and the second anchor portion 26B is in a standbyposition.

When in the position of FIG. 6, a user U can navigate the surgicaldevice 10 within a joint space 76, as illustrated in FIG. 7. The jointspace 76 in FIG. 7 is a joint cavity in a knee, and is specifically acavity between a femur and a tibia. While a knee joint is illustrated,it should be understood that this disclosure extends to other joints. Asillustrated in FIG. 7, there is a tear 78 in a meniscus 80. The meniscusincludes a medial surface 80M, or interior surface, and a lateralsurface 80L, or exterior surface. The surgical device 10 is used todeploy a plurality of implants in the area adjacent the tear 78 to closethe tear 78 and allow it to heal.

In FIG. 7, a user U penetrates the cannula 14 through the meniscus 80 ina first location where the first anchor portion 26A is to be deployed.In particular, the user penetrates the cannula 14 into the medialsurface 80M and out the lateral surface 80L. Alternatively, the usercould penetrate the cannula 14 into the lateral surface 80L and out themedial surface 80M. When the cannula 14 is in the first location, theuser U applies an input force to the trigger 16, which moves the pusher18 distally. In FIG. 8, movement of the pusher 18 in the distaldirection has deployed the first anchor portion 26A out of the cannula14 and into a desired location adjacent the meniscus 80. FIG. 9illustrates the first anchor portion 26A as it is being deployed in thefirst location adjacent the lateral surface 80L of the meniscus.Further, as shown in FIG. 8, the shuttling rack 64 has moved the secondanchor portion 26B distally within the cannula relative to its positionin FIG. 6.

After the first anchor portion 26A is deployed, the user U can removetheir thumb, for example, from the trigger 16 allowing the trigger 16and pusher 18 to move proximally to the position shown in FIG. 10.Again, proximal movement of the pusher 18 does not move the secondanchor portion 26B proximally because of the arrangement of theshuttling rack 64, discussed above. In FIG. 10, the second anchorportion 26B has moved from a standby position (e.g., FIGS. 6, 8) to thedeploy position (e.g., FIG. 10).

When in the position of FIG. 10, the user U can position the cannula 14in a second location adjacent the tear 78, as shown in FIG. 11. Thesecond location is spaced-apart from the first location of FIG. 7. Oncein the second location, the user U can penetrate the meniscus 80 andmove the trigger 16 in the distal direction, which moves the pusher 18in the distal direction, and deploys the second anchor portion 26B, asillustrated in FIG. 12. FIG. 13 illustrates the second anchor portion26B as it is being deployed in the second location. FIG. 14 illustratesthe suture-implant construct 22 after the second anchor portion 26B hasbeen deployed from a top, or superior, view. As shown, the first andsecond anchor portions 26A, 26B are adjacent the lateral surface 80L ofthe meniscus 80, while the central portion 27 of the sheath spansbetween the first and second anchor portion 26A, 26B, includingextending through the meniscus 80 and along the medial surface 80Madjacent the tear 78.

Once the first and second anchor portions 26A, 26B are deployed, thestrand of suture 24 is tensioned. Doing so cinches or tensions the firstand second anchor portions 26A, 26B such that the sheath 26 essentiallybunches together and forms an anchor. Doing so also closes the tear 78,as generally shown in FIG. 15. The tensioned strand of suture 24 appliesa force to the meniscus 80. The increased width dimension W₁ dispersesthat force over a relatively large area of the meniscus 80, which, asmentioned above, reduces the risk of “tear through.”

While the suture-implant construct 22 includes two anchor portions 26A,26B, additional anchor portions can be used to repair larger tears. Inthat case, the trigger 16 can be activated additional times to deployeach additional implant.

While in FIG. 2 the strand of suture 24 is retained relative to thesheath 26 by being looped-back and affixed to itself, the strand ofsuture 24 could be retained in other ways. FIG. 16, for example,illustrates a suture-implant construct 22′ arranged relative to ameniscus 80 in substantially the same way as FIG. 14. The strand ofsuture 24, in this embodiment, includes a bulb 84 at a distal endthereof. The bulb 84 has a diameter larger than the bore of the sheath26, which prevents the sheath 26 from sliding distally off the strand ofsuture 24. While a loop (e.g., FIG. 2) and bulb (e.g., FIG. 16) havebeen shown, this disclosure extends to other techniques for retainingthe strand of suture 24 relative to the sheath 26.

It should be understood that terms such as “lateral,” “medial,”“distal,” “proximal,” “superior,” and “inferior” are used aboveconsistent with the way those terms are used in the art. Further, theseterms have been used herein for purposes of explanation, and should notbe considered otherwise limiting. Terms such as “generally,”“substantially,” and “about” are not intended to be boundaryless terms,and should be interpreted consistent with the way one skilled in the artwould interpret those terms.

Although the different examples have the specific components shown inthe illustrations, embodiments of this disclosure are not limited tothose particular combinations. It is possible to use some of thecomponents or features from one of the examples in combination withfeatures or components from another one of the examples.

One of ordinary skill in this art would understand that theabove-described embodiments are exemplary and non-limiting. That is,modifications of this disclosure would come within the scope of theclaims. Accordingly, the following claims should be studied to determinetheir true scope and content.

What we claim is:
 1. A surgical device, comprising: a cannula; asuture-implant construct comprising a flexible strand and one or moresheaths, each sheath comprising at least a first anchor portion and asecond anchor portion, wherein the first anchor portion is in a deployposition with respect to the cannula and the second anchor portion is ina standby position proximal to the first anchor portion; and a pushermoveable within the cannula to deploy the first anchor portion and tomove the second anchor from the standby position to the deploy position.2. The surgical device as recited in claim 1, wherein the pusherincludes a tube in contact with the suture implant construct.
 3. Thesurgical device as recited in claim 2, wherein: the one or more sheathsare assembled onto the tube of the pusher over top of the flexiblestrand such that that tube passes through a bore of each of the sheaths.4. The surgical device as recited in claim 1, wherein the pusherincludes a shuttling rack in contact with the second anchor portion whenthe second anchor portion is in the standby position.
 5. The surgicaldevice as recited in claim 4, wherein the shuttling rack includes aplurality of barbs.
 6. The surgical device as recited in claim 1,wherein the pusher comprises a holder tube that extends through the oneor more sheaths and moves freely with respect to the one or moresheaths.
 7. The surgical device as recited in claim 1, wherein: eachsheath has a first end and a second end, the first anchor portion isadjacent the first end of the sheath, the second anchor portion isadjacent the second end of the sheath, the strand of suture passesthrough a bore of the sheath between the first and second ends, and thesheath has an increased width dimension between the first and secondanchor portions.
 8. The surgical device as recited in claim 1, wherein:each sheath and the respective first and second anchor portions areone-piece.
 9. The surgical device as recited in claim 1, wherein: theflexible strand is a suture.
 10. A method, comprising: moving a pusherof a surgical device in a distal direction to deploy a first implant ofa suture-implant construct out of a cannula and to move a second implantof the suture-implant construct distally within the cannula; moving thepusher in a proximal direction; and moving the pusher in the distaldirection again to deploy the second implant out of the cannula.
 11. Themethod as recited in claim 10, wherein the first and second implants areimplanted into a meniscus to repair a tear in the meniscus.
 12. Themethod as recited in claim 10, wherein the pusher includes a shuttlingrack having barbs inclined such that the shuttling rack only moves thesecond implant in the distal direction.
 13. The method as recited inclaim 12, wherein the pusher is biased in the proximal direction, andwherein the steps of moving the pusher in the distal direction includeapplying an input force to a trigger to overcome the bias in theproximal direction.
 14. The method as recited in claim 13, furthercomprising braking the pusher to hold the position of the pusher aftermoving the pusher in the distal direction and before the pusher movesback to the proximal direction under the bias.